Infection of the intervertebral space following conventional and microsurgical operation on the herniated lumbar intervertebral disc a controlled clinical trial

Dauch, W. A.

doi:10.1007/bf01456318

Cited by 54 publications

(28 citation statements)

References 46 publications

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“…Several authors have described an even further reduction of operative morbidity subsequent to microneurosurgical techniques being introduced [t, 5,12]. Thus patients and surgeons alike now place great emphasis on operative quality.…”

Section: Introductionmentioning

confidence: 99%

The C-reactive protein for detection of early infections after lumbar microdiscectomy

Meyer¹,

Schaller²,

Rohde³

et al. 1995

Acta neurochir

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The tendency for short hospitalization after lumbar microdiscectomy implies the need for early confirmation or disapproval of serious postoperative infections such as spondylodiscitis or deep wound infections. The C-reactive protein (CRP) is a well-known screening parameter for monitoring postoperative infectious complications in other fields. Our objective was to establish the diagnostic significance of CRP-in comparison with ESR and WBC-for monitoring infectious complications after lumbar microdiscectomy. Over a 15 months period we studied prospectively a homogeneous group of N = 400 patients with lumbar disc herniations who were operated on a single level for the first time. CRP, ESR and WBC values were determined in all patients pre-operatively, and on postoperative days 1 and 5. Clinical and laboratory findings were correlated and the diagnostic significance of CRP, ESR and WBC calculated. N = 385 (96%) patients had an uneventful postoperative course. N = 15 (4%) patients developed infectious complications, of which N = 6 (1.5%) were unrelated and N = 9 (2.5%) related to surgery. Evaluation of the laboratory values showed: The CRP baseline is a very individual value of no prognostic relevance. A high postaggression peak is typical and essential as a reference value for only the future time course will disclose any infection. We found 0% false negative and 4% false positive results on day 5. The sensitivity for serial CRP testing was calculated as 100% and specificity as 95.8%. ESR (sensitivity: 78.1%/specificity: 38.1%) and WBC (sensitivity: 21.4%/specificity: 76.8%) both failed to reach such distinct diagnostic significance on day 5. The C-reactive protein has thus proved to be a reliable, simple and economical screening test for infectious complications after lumbar microdiscectomy, superior to classical laboratory parameters.

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Section: Introductionmentioning

confidence: 99%

The C-reactive protein for detection of early infections after lumbar microdiscectomy

Meyer¹,

Schaller²,

Rohde³

et al. 1995

Acta neurochir

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“…19 , parece haver aumento crescente na incidência das discites primárias na segunda metade do século passado, provavelmente devido a melhores meios diagnósticos (0,2% da década de 50, 0,8% na de 60 e 1,4% dos anos 70). Ao que parece, o traumatismo cirúrgico (principalmente quando utilizadas curetas), reoperações e restos de tecido necrótico no espaço discal agem como "locus minoris resistentiae" e favorecem ao alojamento e proliferação de bactérias 19 .…”

Section: Vhs Inicialunclassified

Espondilodiscites sépticas: diagnóstico e tratamento

Leal

Tella

Bonatelli

et al. 2003

Arq. Neuro-Psiquiatr.

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RESUMO -Estudamos retrospectivamente 24 pacientes com espondilodiscite séptica de diferentes etiologias (hematogênica, primária e infantil) e os diferentes aspectos envolvidos em seu diagnóstico e tratamento. Constatamos que a velocidade de hemossedimentação é um bom parâmetro laboratorial para acompanhar a evolução da doença, mas deve ser sempre interpretada conjuntamente com o quadro clínico e os achados de neuroimagem. Biópsias devem ser reservadas para os casos de diagnóstico duvidoso e o tratamento clínico realizado sempre que afastadas as seguintes condições: sepse, déficit neurológico, deformidade severa, abscesso epidural e corpo estranho (discite primária). A abordagem cirúrgica deve ser planejada levando em conta o estágio da doença, sendo preferencialmente por via posterior nas fases supurativas e anterior nas demais. Baseados em nossa experiência e em revisão da literatura, propomos um algoritmo para orientar o diagnóstico e o tratamento das espondilodiscites sépticas.PALAVRAS-CHAVE: discite séptica, espondilodiscite séptica, osteomielite vertebral.Septic spondylodiscitis: diagnosis and treatment Septic spondylodiscitis: diagnosis and treatment Septic spondylodiscitis: diagnosis and treatment Septic spondylodiscitis: diagnosis and treatment Septic spondylodiscitis: diagnosis and treatment ABSTRACT -We studied retrospectively 24 patients with septic discitis of different etiologies (hematogenic, primary and infantile) and the different aspects involved in its diagnosis and treatment. Erythrocyte sedimentation rate proved to be a valuable parameter and should always be interpreted carefully along with the clinical and neuroimaging findings. Biopsies should be reserved for doubtful cases with atypical course. Clinical treatment should be initiated after the following situations have been ruled out: sepsis, neurological deficit, severe deformity, epidural abscess and foreign body (primary disease). The surgical approach may be chosen based on the stage of disease, being preferably posterior in suppurative forms and anterior in the nonsuppurative stage. Based on our experience and on information gathered by literature review, we propose an algorithm to guide diagnosis and treatment in patients with septic discitis. KEY WORDS: septic discitis, septic spondilodiscitis, vertebral osteomyelitis. A espondilodiscite séptica ainda representa um desafio ao médico, quanto ao seu diagnóstico e tratamento. A literatura neurocirúrgica é muito escassa sobre o assunto e a maioria das publicações está distribuída entre especialidades como ortopedia, clí-nica geral, reumatologia, pediatria e radiologia. Embora sua fisiopatologia não seja completamente esclarecida, a maioria dos trabalhos é retrospectiva, formas diferentes da doença sendo agrupadas das mais diversas maneiras. Termos como espondilodiscite, discite infantil e osteomielite vertebral são empregados como doenças diferentes, não se fazendo distinção entre adultos e crianças de diferentes idades e a inexistência de uma classificação universalmente aceita torna d...

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“…Spondylodiscitis occurs as a complication after lumbar disc surgery with a frequency of 0.1% to 3.0% [2,6,16]. The diagnosis of this disease is firstly dependent upon documentation of the clinical picture.…”

Section: Introductionmentioning

confidence: 99%

“…The diagnosis of this disease is firstly dependent upon documentation of the clinical picture. This may be backed up by non-specific inflammation parameters such as ESR and CRP [1, 2,5,8,16]. Confirmation of diagnosis by MRI is not possible, however, until after about 3 to 4 weeks, and by conventional radiological tomography usually not until about 6 to 8 weeks after surgery [1,16].…”

Section: Introductionmentioning

confidence: 99%

PMN granulocyte elastase ? An early indicator of postoperative spondylodiscitis?

Schneider¹,

Wildförster²,

Diekmann

1995

Acta neurochir

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The diagnosis of spondylodiscitis after lumbar disc surgery has been based so far on clinical abnormalities, non-specific changes in chemical laboratory parameters [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] and radiological examinations such as MRI. Such techniques do not enable any clear diagnosis to be made before the 3rd postoperative week. The PMN elastase released from stimulated polymorphonuclear granulocytes has been proved to be a good laboratory parameter by which it is possible to prognosticate bacterial and abacterial organ complications in surgical patients with a high degree of probability. Under investigation were 12 patients with spondylodiscitis out of 1162 operations on herniated lumbar discs. PMN elastase was determined on the 7th postoperative day. In patients with spondylodiscitis and a mean value of 110.5 micrograms/l, the elastase was on average higher by a factor of 2.6 as compared to 88 randomly selected control patients. Since spondylodiscitis is a rare complication, this results in a positive value of only 7%, which does not allow a reliable diagnosis of spondylodiscitis by the elastase assay. But because the negative predictive value is 100%, it is possible to exclude a postoperative spondylodiscitis already on the 7th postoperative day, if the elastase value is normal.

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Infection of the intervertebral space following conventional and microsurgical operation on the herniated lumbar intervertebral disc a controlled clinical trial

Cited by 54 publications

References 46 publications

The C-reactive protein for detection of early infections after lumbar microdiscectomy

The C-reactive protein for detection of early infections after lumbar microdiscectomy

Espondilodiscites sépticas: diagnóstico e tratamento

PMN granulocyte elastase ? An early indicator of postoperative spondylodiscitis?

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